Tag Archives: alcoholism

Parents want the best for their kids. Mothers and fathers take steps to ensure their children have as little risk exposure as feasible. Preventing one’s son or daughter from making mistakes is no easy challenge; a task which gets more difficult as children mature. The majority of people with children shield their kids from engaging in alcohol and substance use as much as possible. Many parents understand the risks of developing unhealthy relationships with substances at a young age, notably the risk of alcohol use disorder or drug addiction.

Going one step further, a good number of parents grasp the susceptibility of developing brains. Adolescents who experiment with drugs and alcohol use are at an exponentially higher risk of developing alcohol or substance use disorders. With that in mind, it’s entirely critical that parents not do anything that might encourage the development of such problems.

There is a mindset shared by a good many parents, the idea that teenage alcohol use is safe when they, as parents, manage the conditions of use. The resignation that teens are going to drink alcohol regardless of the wisdom imparted to them by their elders leads to the above course of thinking. Some parental units decide that they alone can teach their children how to deal with alcohol responsibly, i.e., moderation, not drinking and driving, etc. Notwithstanding parents’ ability to justify supplying their teens with alcohol, scientific evidence suggests that the behavior may lead to more detriment than benefit.

Parental Provision of Alcohol Use

A long-term study involving 1927 teenagers aged 12 to 18 and their parents, should help to debunk some of the myths mothers and fathers have about alcohol. The six-year analysis shows no significant benefits tied to providing teens alcohol, The Lancet reports. In fact, one could interpret the findings as evidence that parental provisional alcohol use heightened the risk of problems down the road. The researchers point out that alcohol use is the number one cause of “death and disability in 15-24-year-olds globally.”

The research indicates that when parents supply teens with alcohol in one year, it doubled the risk the teens would access alcohol from other people in the following year, according to the article. The same teens were found at most significant risk of engaging in binge drinking and experiencing harm from alcohol use; notably, alcohol abuse, dependence, and alcohol use disorders. There’s no evidence to support the idea that parents supplying teens with alcohol leads to responsible alcohol use.

In many countries, parents are a key provider of alcohol to their children before they are of legal age to purchase alcohol. This practice by parents is intended to protect teenagers from the harms of heavy drinking by introducing them to alcohol carefully, however, the evidence behind this has been limited," says lead author Professor Richard Mattick, University of New South Wales. "Our study is the first to analyse parental supply of alcohol and its effects in detail in the long term, and finds that it is, in fact, associated with risks when compared to teenagers not given alcohol. This reinforces the fact that alcohol consumption leads to harm, no matter how it is supplied. We advise that parents should avoid supplying alcohol to their teenagers if they wish to reduce their risk of alcohol-related harms."

Binge Drinking

The Centers for Disease Control and Prevention (CDC) defines binge drinking as when men consume 5 or more drinks, or women consume 4 or more drinks in about 2 hours. Essentially, drinking an excessive amount of alcohol in a short period. The risks of this behavior are many, and young people rarely understand the inherent pitfalls of heavy alcohol use. What’s more, parents are not an exception; otherwise, they may think twice about introducing their children to alcohol in any environment.

At the end of the study, binge drinking was reported among:

81% of teenagers who accessed alcohol through their parents and others reported binge drinking.

62% of those who accessing alcohol from other people only.

25% of teens whose only supply came from parents.

It’s worth mentioning that the longer a person refrains from substance use of any kind, the better. Adolescence does not end until a person is in their mid-twenties, which means the brain is still developing. Exposing our most important organ to alcohol while it’s taking shape can cause many problems, including mental illness. The effects alcohol has on the brain tend to be more pronounced when heavy alcohol use occurs. Notwithstanding the laws that allow for alcohol use, everyone can benefit from using alcohol as intermittently and sparingly as possible.

Alcohol Use Disorder Treatment

Adolescent alcohol use often progresses to alcohol use disorder in young adulthood. Once that transition occurs, there is no turning back the clock. However, those caught in the grips of alcoholism can recover, provided they have help.

America has had a tumultuous relationship with alcohol since before we declared independence from Great Britain. In many ways, alcohol helped shape the nation we would become. After all, it was the whiskey drinking frontiersman that helped us achieve, at great moral costs, our manifest destiny. Over the centuries, the substance, and how it affected people, tested our humanity forcing us to take a hard look in the mirror.

The general public's perception of the alcoholic has taken many forms over the course of our history. From the godless and morally weak individual to the person suffering from a debilitating mental illness whom we see today. As with any mental health disorder, society's response to it over the decades has been anything but humane until the last few decades. But the story of alcoholism in America is as much about sobriety as it is about self-destruction. What’s more, every now and again we should pause. Take a moment, and consider the centuries’ long road to get where we are today regarding the disease of addiction in America.

We still have a long way to go, but addiction recovery in America is something to marvel over. The fact that we have recovery programs today rooted in compassion rather than punishment came at great pains. The history of which, is absolutely fascinating. It is worth remembering that Americans have been trying to recover from alcoholism since the 1700’s. We might consider this a nearly impossible task given the stigma that has long been attached to anyone who could not control their drinking. Given the terrible treatments imposed upon such people, right on into the twentieth century. And yet, in the wake of World War I, two people stumbled upon a method to achieve the goal of sobriety. Spawning a movement that would reshape public opinion about addiction.

Recovery in America, A Great Liberation Movement

You are in a 12-Step meeting today, looking around at people working towards the common goal of recovery, it can be hard to fully grasp how this all came to be. If you have spent some time reading the Big Book you know a little bit about the founders of Alcoholics Anonymous. You learned what worked for people and what didn't. It is a program that works, and everyone working the program should be grateful for the thousands of people who helped make it what it is today. But there is more to the story of recovery in America than meets the eye. A subject matter that one author decided to tackle.

Drunks: An American History, by Christopher M. Finan, was published last week by Beacon Press, VICE News reports. Beginning in the 17th century, the book tells the story of the many movements over the years to encourage sobriety in America. Believe it or not, Finan found the first evidence of prohibition in America dating back to the Massachusetts Bay Colony in 1633. From Native Americans battling the grips of whiskey introduced by settlers right on through Betty Ford’s new treatment center in the 1980’s.

The author himself comes from a long line of alcoholics, according to the article. Finan points out that the modern view of addiction is the byproduct of centuries of advocates and alcoholics putting up the good fight. The book talks about the doctors who had an important role in showing that alcoholism was not a moral failing, but a disease from which it was possible to recover. Finan calls sobriety one of the "great liberation movements."

Drunks: A History of People Trying to Get Free

Naturally, it would be impossible to cover all that is included in the book in this short article. But we would be remiss if we didn’t include a few tidbits from an interview Finan gave to VICE writer Rachel Riederer. One of the more interesting points of the book includes a quote from Abraham Lincoln that the news organization asked about.

I love the Abraham Lincoln quotation that you include about the "heads and hearts of habitual drunkards." It's a warm description—very different from the way that many others talk about drunks.

"It is a constant theme, to push back against the image of them as the town drunks, the degenerates, and to make the point that alcoholism affects all classes of society and it afflicts the best and brightest. It's often a reaction to how terrible the stigma was against alcoholics: the idea that alcoholics deserved to suffer because they were bad people, they were criminals, they were weaklings, they were sinners. The tremendous humanitarianism of Lincoln is well-known, but I hadn't known until I started working on this book that it extended to drunks."

The final interview question touched on treating addiction in America today.

I'm curious about what you think about the current culture around drinking and sobriety.

"I think that a lot of the progress we've made is permanent. As long as people are staying sober and can remember what it was like for them, whether in AA or some other sobriety group, this is one of the defining experiences of their lives and they aren't about to let anybody deny or diminish the truth of what they've experienced. [But] alcoholism is still a tremendous problem, and the amount of treatment is completely inadequate…"

Alcohol Use Disorder Treatment

Anyone who has been touched by the disease of addiction, or has a loved one struggling with it may want to pick up a copy of the book. It is a history that led to the effective methods of treatment that are utilized today across the country. Methods that are still being enhanced and improved upon. If you or family members are in need of help for an alcohol use disorder, please contact PACE Recovery Center today. Our highly trained staff employs scientific, evidence-based techniques to help break the cycle of addiction. In conjunction with the 12-Steps, clients have the best chance of achieving continued, long-term sobriety from alcohol. Going on to live fulfilling and productive lives.

The American opioid addiction epidemic has long been a top priority among lawmakers and health experts. The scourge of opioid abuse across the country has resulted in thousands of premature deaths, the result of overdoses. If you have been keeping yourself apprised of efforts to curb opioid use and abuse rates, it is likely that you have heard or read statements indicating that the opioid epidemic is unprecedented.

A claim that is spot on when it comes to the abuse of drugs. What makes opioid abuse so pernicious is the fact that technically, someone can overdose at any time. People often say that addiction is a slow death, dying spiritually at first and then expiring physically down the road—often decades later. Not so with opioid use disorder. But, if we were to step back and look at addiction in America as a whole, one could easily argue that the most severe addiction epidemic that the U.S. has ever faced and continues to struggle with is tied to a substance that is legal for adult consumption. Alcohol is a drug that is responsible for far more deaths every year than opioid narcotics, such as OxyContin or heroin. However, opioid addiction receives far more attention than AUD.

Alcohol, like prescription drugs, is a multibillion dollar enterprise. Despite the deadly nature of heavy alcohol use, the substance is both legal and is considered to be a socially acceptable for both relaxation and celebration. The substance can be acquired with little effort, there are no rules about how much can be purchased or used at one time. Suffice it to say, one can drink themselves to death without out any checks and balances. Unlike a doctor who may stop prescribing a drug because of concerns of abuse, liquor stores will sell booze to anyone with a pulse.

Alcohol Abuse Figures of Interest

A few years ago a National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) revealed that over 20 million Americans consumed alcohol at potentially dangerous levels. The data was analyzed by author Philip J. Cook, and used for a book titled, “Paying the Tab: The Costs and Benefits of Alcohol Control.” NESARC data revealed that 24 million adults (18 +) - drink an average 74 alcoholic beverages every week—about 10 drinks a day. A lot of alcohol to be sure.

In the following year, the National Survey on Drug Use and Health (NSDUH) showed that 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month. What’s more, the survey indicated that 15.1 million adults had an alcohol use disorder (AUD), a figure made up of 9.8 million men and 5.3 million women. While those figures are staggering, perhaps the most concerning finding was that about 1.3 million adults received treatment for AUD at a substance use disorder center in the same year.

Alcohol and Opioids—A Common Tie

If one were to try and find a silver lining regarding the American opioid addiction epidemic, you may think that it would be a difficult task considering the death toll. However, the crisis has brought to light the fact that there is a real lack of addiction treatment services in this country. A reality that brought about the passing of legislation that would, among other things, expand access to addiction treatment.

Substance use disorder treatment centers utilize effective science-based therapies to help people save their own lives. In conjunction with medication and introducing patients to recovery support groups (i.e. 12-Step programs and SMART Recovery), people with the disease of addiction can have a real chance at sustained abstinence for decades. Many facilities have started to take advantage of certain medications that can help clients after being discharged avoid relapse. One such drug is naltrexone, commonly sold under the brand name Vivitrol ® has been used for years on opioid addicts.

Naltrexone has been found to have an impact on opioid cravings, it can deter relapse by blocking the euphoric feelings produced by opioid use. One can take an OxyContin, but not get high. Interestingly, science shows that both opioids and alcohol impact some of the same receptors in the brain. So, it stands to reason that naltrexone may help alcoholics curb their drinking. Studies indicate that Vivitrol can decrease the pleasure that comes with drinking alcohol, NPR reports. If you reconsider the survey that showed only a small fraction of alcoholics go to treatment, it is vital that primary care physicians utilize the drug which research shows has been historically underused.

Alcohol Use Disorder Treatment

If you are one of the millions of Americans who has an unhealthy relationship with alcohol, we implore you to seek help immediately. The problem, as with any addiction, it will only get worse. Alcohol use disorder is a progressive disease, without treatment it can be fatal. Please contact PACE Recovery Center to begin the journey of recovery. We specialize in treating young adult males, and have helped many people start the journey of recovery. Here’s to life!

With all the talk about prescription opioid and heroin addiction devastating communities across the country, it is important that we do not lose sight of the other substances which have the power to negatively affect one’s life. We’ve written before how alcohol continues to be, and will probably always be, the most commonly used drug here in the United States and around the world. In America, alcohol is the third leading cause of preventable death, and every year approximately 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Educating young adults about the dangers that can accompany alcohol use, especially regarding the dangerous practice of “binge drinking,” can save lives. Four out of five college students report drinking alcohol and half of those who drink - binge drink. The NIAAA considers binge drinking as having 5 alcoholic beverages for men and 4 for women within a two hour period. The dangerous practice is associated with a number of serious health problems, including:

Alcohol Poisoning

Unintentional Injuries

Liver Disease

Neurological Damage

It is probably fair to say that many young adults who binge drink, developed an unhealthy relationship with alcohol in high school. While heavy drinking is more commonly associated with college life, it occurs among high school age teens as well. Left unchecked it can result in an alcohol use disorder developing, an addiction that can dramatically affect the course of one’s life. It is ever vital that we have effective prevention and intervention efforts, and that health experts do everything in their power to provide teenagers and young adults with scientifically current information about the dangers of alcohol use.
Naturally, parents can play a huge role in preventing their teens and young adult children from forming unhealthy relationships with alcohol. It cannot be overly stressed how paramount it is that parents talk with their children about alcohol, which is why the theme of this year’s Alcohol Awareness Month is: “Talk Early, Talk Often: Parents Can Make a Difference in Teen Alcohol Use.” Every year in April, the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) sponsors Alcohol Awareness month, with the aim of raising “public awareness and understanding, reduce stigma and encourage local communities to focus on alcoholism and alcohol-related issues.”
The leading advocacy organization in the world addressing alcoholism and drug dependence cites research that found that adolescents who have regular discourse with their parents about the dangers of alcohol and drug use are 50% less likely to use. Young people who drink alcohol are at great risk of:

Addiction

Alcohol Poisoning

Traffic Fatalities

Violence

Suicide

Unsafe Sex

Educational Failure

“Alcohol and drug use is a very risky business for young people,” says Andrew Pucher, President and Chief Executive Officer of NCADD, “and parents can make a difference. The longer children delay drinking and drug use, the less likely they are to develop any problems associated with it. That’s why it is so important to help your child make smart decisions about alcohol and drugs.”
Nevertheless, there are many young adults who are already struggling with an alcohol use disorder and it is vital that they receive help sooner, rather than later. If you or a loved one’s alcohol use has become problematic, please contact PACE Recovery Center. We specialize in treating young adults with chemical dependency and behavioral health issues.

Always give a word or sign of salute when meeting or passing a friend, or even a stranger, if in a lonely place. Tecumseh

The Korean War Veterans Memorial is located in Washington, D.C.'s West Potomac Park, southeast of the Lincoln Memorial and just south of the Reflecting Pool on the National Mall. It commemorates those who served in the Korean War.
Tecumseh is gone now over 200 years, but his words still echo when we consider the power of a nod of understanding and appreciation for the men and women who have served our country throughout times of war and peace. So again, PACE salutes VeteransNovember 11, 2015: We will stop what we are busy doing, maybe just for a few minutes, and consider the sacrifices made by our veterans to build and protect our freedoms and those of other countries.

Understanding veterans with addiction and PTSD, at the movies...

Over the past couple of years there have been a number of movies about war and PTSD, such as American Sniper,Unbroken and Railway Man. Two of these movies dealt directly with the impact of PTSD, and while Unbroken didn’t deal with Zamperini’s alcoholism and PTSD many of his family members will attest to his suffering from both and receiving help for his addiction and PTSD.
Post traumatic stress disorder (PTSD) is the term we have used for the past few decades to describe what many veterans experience as the result of service in times of war and minor conflicts. Over the centuries, the definitive terms were hysteria, melancholia, battle fatigue, combat fatigue, shell-shock, or operational exhaustion. In 2015 The Wounded Warrior Project conducted an annual survey of 23,000 injured service members and found that three in four wounded veterans are dealing with PTSD.
This month a film completed in 2014 is now more widely available to view in the United States - Of Men and War. According to The Hollywood Reporter, “...the horrors of the battlefield come home to roost in ways that are both riveting and deeply disturbing in Of Men and War(Des hommes et de la guerre), a remarkable chronicle of Iraq War veterans suffering from the devastating effects of PTSD.” This month Of Men and War will have playdates across the United States, including Southern California.
Learning from films can be personal, powerful, and provocative.

PACE is honored by the service of veterans and our psychiatrists’ specialized skills

Matthew Johnson
On Veterans Day 2013 we proudly featured two veterans who serve on our staff: Sean Kelly, now PACE’s Chief Operation Officer and Victor Calzada, A PACE Resident Manager. This year we want to also recognize Matthew Johnson, A PACE Resident Manager who served four years in the Marine Infantry and highlight our Consulting Psychiatrists who are experts in the field of addiction and skilled in working with those suffering from PTSD, including veterans.
Dr. Hisham Korraa, M.D. is a UCLA trained psychiatrist specializing in psychotherapy and medication management for adults and adolescents. With a heavy emphasis on addressing the individual, Dr. Korraa’s treatment focuses on variables that would impact the individual’s development and coping patterns over the course of the years.
Dr. Korraa developed a special interest in helping individuals overcoming their chemical dependency issues and addressing underlying core struggles to focus on growth and health. Dr. Korraa works well with several different chemical dependency programs in Orange County including PACE Recovery Center and he maintains a strong relationship with his patients well after their acute recovery period.
Dr. Korraa did his undergraduate training at University of Houston. He later graduated from Texas Tech School of Medicine. He then specialized in Psychiatry at the reputable UCLA/Sepulveda Training Psychiatry Program. Being exposed to several different facilities in the Los Angeles area (with much exposure to veterans in the greater LA VA and Sepulveda VA program), Dr. Korraa became well versed in PTSD and chemical dependency. In addition to psychopharmacology and individual therapy, Dr. Korraa is one of the very few physicians who also specializes in both the transcranial magnetic treatment of depression and deep brain nerve stimulation of obsessive compulsive disorder.
Dr. Korraa has been awarded multiple awards over the course of the years. He has been recognized by his patients with several “Patient’s Choice Award” and “Compassionate Doctor Recognition”. He has also been recognized as among the best rated doctors in the area.
Dr. Ryan Wright, M.D. is a Diplomate of the American Board of Psychiatry and Neurology. He completed college, medical school, and residency at the University of California, Irvine. While in college, Dr. Wright graduated Magna cum laude from the school of Biological Sciences at UCI, was invited to join the national honors society Phi Beta Kappa, and graduated from the Campuswide Honors Program at UCI.
During medical school and residency at UCI, he received extensive training on treating a wide range of psychiatric disorders utilizing both medication management and psychotherapy. Dr. Wright worked extensively at the Long Beach VA treating veterans for post traumatic stress disorder. He successfully mastered the skill of using cognitive behavioral therapy to improve the quality of life of veterans after returning home from overseas. During his final year of his residency, Dr. Wright elected to spend a significant portion of his year working at a substance abuse treatment facility in Orange County in order to gain specialized training in the field of chemical dependency. This experience allowed him to treat psychiatric patients who have a co-morbid substance abuse diagnosis.
Dr. Venice Sanchez, M.D. received her Bachelor’s degree from University of California, Los Angeles and Medical Degree from Michigan State University College of Human Medicine. She continued her training at the University of California, Irvine Psychiatry Residency Program where she was recognized by faculty with the Outstanding Resident of the Year Award as an acknowledgement for her dedicated efforts in education, the clinics and her work with her patients.
Dr. Sanchez has had extensive training at multiple facilities under supervision of experts in her field, which allowed her to gain comprehensive knowledge and experience in treating a wide array of psychiatric disorders. Her work at Long Beach VA, Pat Moore Rehabilitation Center, San Diego Detention facilities allowed her to gain expertise in Post Traumatic Stress Disorder, Substance Abuse and mood and thought disorders underlying the substance use. Dr. Sanchez realizes the significant need in women’s health, especially in treating pregnant and post-partum patients who are struggling with mental illness. She not only trained with a specialist at the Maternal and Fetal clinic at UCI Medical Center, she was also a forefront in opening up the first Women’s Mental Health Medication Management Clinic at Long Beach VA Veteran’s Hospital. Her passion for her field allowed her to diligently pursue the much needed training and experience in treating patients who have a co-morbid psychiatric diagnosis.

In closing…

PACE Recovery Center staff and the gentlemen whom we treat salute all veterans, remembering their sacrifices. Gratefully the enormity of these sacrifices is memorialized in monuments in our nation’s capital (see below) and throughout our country with national cemeteries that provide a final resting spot, a permanent salute to our veterans.
___________________________________________________________________________
If you are or a loved one is struggling with a substance use disorder, please contact Pace Recovery Center.The United States Marine Corps War Memorial is a United States military monument sited at the back entrance to Arlington National Cemetery .The World War II Memorial is a memorial of national significance dedicated to Americans who served in the armed forces and as civilians during World War II.The Vietnam Women's Memorial is a memorial dedicated to the women of the United States who served in the Vietnam War, most of whom were nurses. It serves as a reminder of the importance of women in the conflict.

Millions of people around the world are currently working programs of recovery, determined to live a life free from all mind altering substances and to be productive members of society. While the nation and the rest of the world have a long way to go with regard to understanding that addiction is a treatable disease, one that should be openly discussed to break the stigmas that have long been associated with drug and alcohol use - in recent years Americans have come a long way and addiction is no longer viewed as a moral failing.
The Internet has played a large role in bringing addiction out into the open, and has become a vital tool for those looking for information or help for themselves and/or a loved one. There are hundreds of organizations that are devoted to breaking the stigma of addiction, so that those who are struggling can receive the help that they so desperately need. One such organization, is the National Council on Alcoholism and Drug Dependence (NCADD), an advocacy organization which has been addressing alcoholism and drug dependence since 1944 - the oldest of its kind in the nation.
Last week, via a press release, NCADD announced the launching of their new website which encompasses the organization’s commitment to educating Americans about substance use disorders. The organization's goal is to inform people about the fact that addiction is treatable, preventable and millions of people do recover.
The new website gives users the ability to access a wide range of information that both addicts and their loved ones can harness to make informed decisions. The NCADD site works on multiple platforms, and is an inclusive resource that people can turn to for more information about alcoholism, drug dependence and options individuals can turn to for finding recovery.

We have reconfigured the website to reach more people,” says NCADD President Andrew Pucher, “making it easier for those searching for answers about alcoholism and drug dependence to find them - regardless of what device they choose to utilize.”

In the 21st Century, those battling with addiction are fortunate to have resources as informative as the NCADD at their fingertips, which could not be more useful at a time when our nation continues to face an insidious opioid epidemic; a scourge linked to thousands of overdose deaths every year. Learning that you are not alone can often be the catalyst required for people to reach out for help in the form of treatment and/or 12 step programs.
NCADD makes available a number of personal recovery stories that people can not only learn from, but relate to - the tie that binds. While every story of addiction is different, the underlying themes are the same, which are easy for any addict or the loved ones of an addict to identify with. One’s story of recovery is the common bond, recovery is not possible alone.

Alcoholism will now be diagnosed on a spectrum, including mild, moderate, and severe. Historically, doctors divided problematic drinking into two categories, alcohol abuse and alcohol dependence. The new criteria for alcoholism in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), no longer includes abuse and dependence diagnoses, Science Daily reports. Now, there is a single alcohol use disorder diagnosis.
Under the new criteria, new research suggests that a third of adults have an alcohol use disorder, and just 20 percent seek treatment for their disease. Having a single drink per day could put one at risk, depending on family history and behavior.
Diagnosing an alcohol use disorder now involves an 11 item criteria list, according to the article. Mild alcohol use disorder requires having two or three criteria from the list, while a severe diagnosis requires six or more. Worldwide, alcohol use disorders affect more people than any other mental health condition. In the United States, researchers found an alcohol use disorder lifetime prevalence of 29.1 percent - but only 19.8 percent of adults were ever treated.

"Most importantly, this study highlighted the urgency of educating the public and policymakers about AUD [alcohol use disorder] and its treatments, destigmatizing the disorder and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment," the study concludes.

The research indicated that the 12-month prevalence of alcohol use disorder under the new DSM-5 criteria was 13.9 percent and the lifetime prevalence was 29.1 percent. The aforementioned percentages equate to approximately 32.6 million and 68.5 million adults.
The findings were published in the journal JAMA Psychiatry.